Why Value Based Health Care Can Be Costly for People in Medicare

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Why Value Based Health Care Can Be Costly for People in Medicare

Cost inequity

In this Next Avenue article, you'll learn about:
  • Experts concerns with Medicare Advantage Plans

" Medicare Advantage plans often adopt a "gatekeeper" system, requiring patients to see clinicians who aren't doctors partly because they're paid less. These might be nurse practitioners, physician assistants, registered nurses, medical assistants and community health workers. "

  • Problems for people with chronic diseases

" "Payment incentives and quality measures can lead to a lot of folks with chronic conditions being left behind."

"People with chronic conditions have all sorts of barriers to care in Traditional Medicare; we see that exacerbated with Medicare Advantage plans," he said at the American Society on Aging's national conference I attended in April 2022. "

  • Concerns around home health care

" Lipschutz predicts we'll see value-based care problems in home health care exacerbated next year. That's when Medicare moves toward "a change in the payment systems that will pay providers more on the front-end at the outset of care and pay less as care goes on," he noted.

He fears that system won't adequately account for a situation where someone with home health care isn't going to get better "or isn't going to get better fast enough" for Medicare's bonus reimbursements. "

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